Wolfson Institute of Population Health, Queen Mary University of London, Asthma UK Centre for Applied Research, London, UK
Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, Asthma UK Centre for Applied Research, London, UK.
BMJ Open. 2021 Oct 29;11(10):e053268. doi: 10.1136/bmjopen-2021-053268.
To test the feasibility and acceptability of a short-term reminder and incentives intervention in adolescents with low adherence to asthma medications.
Mixed-methods feasibility study in a tertiary care clinic. Adolescents recruited to a 24-week programme with three 8-weekly visits, receiving electronic reminders to prompt inhaled corticosteroid (ICS) inhalation through a mobile app coupled with electronic monitoring devices (EMD). From the second visit, monetary incentives based on adherence of ICS inhalation: £1 per dose, maximum £2 /day, up to £112/study, collected as gift cards at the third visit. End of study interviews and questionnaires assessing perceptions of asthma and ICS, analysed using the Perceptions and Practicalities Framework.
Adolescents (11-18 years) with documented low ICS adherence (<80% by EMD), and poor asthma control at the first clinic visit.
10 out of 12 adolescents approached were recruited (7 males, 3 females, 12-16 years). Eight participants provided adherence measures up to the fourth visits and received rewards. Mean study duration was 281 days, with 7/10 participants unable to attend their fourth visit due to COVID-19 lockdown. Only 3/10 participants managed to pair the app/EMD up to the fourth visit, which was associated with improved ICS adherence (from 0.51, SD 0.07 to 0.86, SD 0.05). Adherence did not change in adolescents unable to pair the app/EMD. The intervention was acceptable to participants and parents/guardians. Exit interviews showed that participants welcomed reminders and incentives, though expressed frustration with app/EMD technological difficulties. Participants stated the intervention helped through reminding ICS doses, promoting self-monitoring and increasing motivation to take inhalers.
An intervention using electronic reminders and incentives through an app coupled with an EMD was feasible and acceptable to adolescents with asthma. A pilot randomised controlled trial is warranted to better estimate the effect size on adherence, with improved technical support for the EMD.
测试短期提醒和激励干预在低依从性哮喘药物治疗的青少年中的可行性和可接受性。
在三级护理诊所进行混合方法可行性研究。招募青少年参加为期 24 周的计划，进行三次 8 周的访问，通过移动应用程序和电子监测设备（EMD）发送电子提醒以提示吸入皮质类固醇（ICS）吸入。从第二次访问开始，根据 ICS 吸入的依从性给予金钱激励：每剂量 1 英镑，每天最多 2 英镑，研究期间最高 112 英镑，在第三次访问时以礼品卡的形式收取。在研究结束时进行访谈和问卷调查，评估对哮喘和 ICS 的看法，使用感知和实践框架进行分析。
在第一次就诊时记录到 ICS 依从性低（EMD 低于 80%）和哮喘控制不佳的青少年（11-18 岁）。
在接触的 12 名青少年中有 10 名被招募（7 名男性，3 名女性，12-16 岁）。8 名参与者提供了直到第四次就诊的依从性测量值，并获得了奖励。平均研究持续时间为 281 天，由于 COVID-19 封锁，10 名参与者中有 7 人无法参加第四次就诊。只有 3 名参与者设法将应用程序/EMD 配对到第四次就诊，这与 ICS 依从性的提高（从 0.51，SD 0.07 到 0.86，SD 0.05）有关。无法配对应用程序/EMD 的青少年的依从性没有变化。该干预措施得到了参与者和家长/监护人的认可。退出访谈显示，参与者欢迎提醒和激励措施，但对应用程序/EMD 技术困难感到沮丧。参与者表示，该干预措施通过提醒 ICS 剂量、促进自我监测和提高服药动力来帮助他们。
使用应用程序和 EMD 通过电子提醒和激励的干预措施对哮喘青少年是可行和可接受的。需要进行一项使用随机对照试验来更好地估计对依从性的影响大小，并为 EMD 提供更好的技术支持。
